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By Valley Dev

“Thrival”

Gary Larcenaire, CEO Valley Behavioral Health

 

“Thrive” | Gary Larcenaire | Pulse | LinkedIn

Thrive-oriented cultures ensure that everyone shows up everyday, shaped, guided and informed by the thousands of days, prior.

For thirty years, Valley Behavioral Health has been there to provide care and support for Utahns and family members enduring the consequences of the most complex behavioral health conditions known.

Significant change to contracting protocols resulted in fundamental threat to Valley’s survival in 2011. Five years later, Valley survived. Survival is good. Seriously. But the future of healthcare is now more uncertain as ever. Survival will no longer be good enough. Organizations will need to be oriented toward “thrive” principles if they expect to be around in the longer term.

The “near death” experience we endured at Valley taught us a lot, and our “finely-honed” adaptive skill set will serve us well as we navigate our transition from “survive” to “thrive”.

“Thrive” represents a full transition from a focus on the present and near-term, to the “foreseeable”.

Thrive must be pervasive. Unifying. And unless it becomes a complete cultural imperative, health systems may fail; or be so weakened that we cannot tell the difference.

Only those health systems committed to the principles of thrive, will be around and growing in ten to twenty years.

Thrive-oriented cultures are defined by:

  • An organizational systems approach which seeks to minimize the urgency of “the now” by shifting team orientation to the future and the past.
  • A culture which values, and materially rewards learning from prior experiences, successes and failures,
  • An organizational culture fixated on prior success and learning, so as to inform and better prepare each department/unit/employee for the future.
  • Thrive-oriented cultures are mostly calm.
  •  Thrive-oriented cultures are oriented pro-activly.
  • Thrive-oriented cultures accept failure with enthusiasm and celebrate failure as a recognized source of knowledge and learning.
  •  Thrive-oriented cultures ensure that everyone shows up everyday, informed by the thousands of days, prior.

Read last bullet again slowly and think about its relevance to: Staff Development, Human Resources, Information Technology, Management, Systems Learning, on-boarding, auditing, NEO etc.

Thrive-oriented cultures ensure that everyone shows up everyday, informed by the thousands of days, prior.

  •  Thrive-oriented cultures pivot from crisis intervention to crisis interception.

I look forward to meeting and discussing this more in person.

Follow-up questions:

  1. How can your department/unit be more proactive?
  2. How can you use the experiences of staff both successes and failures to shape the on boarding of new team members?
  3. How can you celebrate failure and use it as a source of learning and future success?
  4. How can you transition from “crisis intervention” to “crisis interception”?

By Valley Dev

Communicate or Die

Gary Larcenaire, CEO Valley Behavioral Health

 

1. Message transmit speed and saturation not measured 

If your executive management team designated Tuesdays as “green t-shirt day” how many Tuesdays would pass before employee participation reached 100%?

This example seems simple enough but one very critical assumption is built into this example: That you have a process of tracking “T-shirt Tuesday participation” over time.

In order for a group to evidence that communication occurred, a specified change in behavior must be observed and measured.

Organizations fail when they fail to adapt. Positive adaptation is a product of clean and efficient communication. Without a formal process to measure and improve message transmission efficiency, your company will be at a significant disadvantage, will inevitably fall behind and may gradually fail.

I recommend you establish a process whereby message saturation and duration can be tested a few times annually. Make it fun! At Valley, we recently challenged Program Directors to disseminate a survey link to all staff in their units. We set up a process and informed Directors that once an employee completed their three-question survey, a set of warm clothes would be donated to our homeless services unit on their behalf.

We then tracked how long it took each unit to reach 100% survey completion. Sure, many of the larger units never did reach 100%, but it did establish a baseline. A baseline each Director has vowed to beat next time.

At Valley, we are developing innovative ways to empirically track communication efficiency and are developing organizational designs which minimize message attenuation.

The attenuation graph is an example of a visual representation of percent loss of message as time or layers of bureaucracy are added. Developing and sharing this visualization of message loss can be a powerful educational tool.

2. Message distortion levels not measured

If your executive management team designated Tuesdays as “green t-shirt day” how many employees would show up wearing blue, black, or sea foam (a shade of green, but not “true” green) shirts?

Message saturation and duration testing, as we have learned, is critical, but how many times are messages transmitted, only to be received in a distorted form?

Inflection adjustment, sarcasm use, or simple lack of clarity in message transmission can result in the wrong behavioral change. This distortion can be more damaging than a team not getting a message at all. We borrowed again from the science of sound, and refer to this as the signal to noise ratio.

The science of sound has developed methods of measuring sound absorption and dissipation and distortion. We are borrowing heavily from this science as we adapt their learning to our organizational learning and adaptation.

We are borrowing heavily from the “science of sound” as we measure and redesign our communication systems.

3. Staff training curriculum and processes not dynamic

Staff training curriculum not “dynamically” influenced by the most recent set of performance metrics will inevitably become stale and useless. Whether training on compliance, clinical outcomes, customer satisfaction, or budget performance, the foundation of effective training, organizational learning and adaptation is the incorporation of current performance metrics. Incorporation of most recent performance data into training materials, combined with experiential learning methods can produce the Holy Grail of training: dynamic knowledge.

Dynamic knowledge steps beyond just “know about” and steps into performance. It is actually doing something with the information, working with it, building skills and understanding on a deeper level.

Dynamic knowledge is to gain a feel for something, to internalize information and have it become real and active in the learner’s world.

Minimizing attenuation and signal to noise ratio isn’t enough. New and existing staff must be trained routinely as new information is discovered or process requirements change. Training must result in dynamic knowledge and the existence of dynamic knowledge must be measured.

4. Lack of prompt “business critical” feedback loops 

Feedback loops are a critical component for organizational learning and adaptation to occur. Single loop learning processes at a minimum must be established so that dynamic training and knowledge acquisition can develop and spread.

Double loop learning and even triple loop processes can be developed over time as team sophistication grows.

Failure to institutionalize learning will compromise organizational agility and adaptation.

By combining the sciences of sound, cutting edge education and organizational theory, a company can move a long way toward becoming a force of adaptation and innovation. But without developing a common language, true realization of synergy from these concepts will remain elusive.

5. Failure to establish a common performance language

The concepts touched on in this blog must be uniformly defined shared and understood. Leadership must make certain that words and concepts like:

  • Attenuation
  • Message Saturation and Duration Testing
  • Signal to Noise Ratio
  • Dynamic Knowledge
  • Dynamic Curriculum
  • Experiential Learning
  • Loop Learning

are taught at New Employee Orientation and leadership training to ensure that they become routine nomenclature within the culture of the company.

Summary

Use the five points listed above as the baseline of an assessment for your company or department. Work to develop your understanding of what is in place and what isn’t. Then act.

You could even start with using your traditional communication channels to launch and monitor a message push similar to “T-Shirt Tuesday”. Let me know what you come up with! I hope this has been helpful. I look forward to our next meeting together.

Gary

By Valley Dev

TrumpCare?

Gary Larcenaire, CEO Valley Behavioral Health

 

The Patient Protection and Affordable Care Act (PPACA), commonly called the Affordable Care Act (ACA) AKA “Obamacare”, enacted by President Barack Obama on March 23, 2010 has been a source of professional and personal angst for me since the beginning. We can discuss the personal side in person!

ACA implementation and Medicaid expansion–provisions of the Affordable Care Act expanded Medicaid to all Americans under age 65 whose family income is at or below 133 percent of federal poverty guidelines by Jan. 1, 2014–has been dogged by political rancor, legal challenges, and constant political vilification since its inception.

As a healthcare administrator in the conservative-leaning Texas, and Utah, the process of forecasting and planning has been rendered nearly impossible. Since 2010, I have experienced feelings of uncertainty and confusion, blended with a heaping dose of “desire to be ready”. That has been a recipe for sleepless nights.

Like my colleagues, I share a deep commitment to my team and community, and expect that our service delivery and software systems will ready for whatever is decided.

Faced with this commitment, and an environment where “uncertainty is the only certainty”, I see little choice but to constantly train my teams to develop “organizational agility and adaptation” as a core strength.

I touch on this in a prior blog: Babies, Baseball and Bikers. Check it out. Let me know your thoughts.

Maybe now, with full control bestowed upon Republicans, in all three branches of Federal Government, and an unprecedented number of statehouses in 2017, we can debate a few undisputed facts:

  1. Our system is more focused on “sick” than ‘health” care.
  2. Our financing and regulatory system is sub-optimal and leads to inefficiencies.
  3. You cannot end homelessness by simply passing a mandate that people buy housing. This same concept likely applies to the uninsured.
  4. Behavioral health and addiction services need to emerge as mainstream healthcare. As acceptable and necessary an aspect of healthcare as any other specialty such as allergy and immunology or ophthalmology.

I hope that now, given the learning that has occurred since 2010, we have a context within which now to finally forge a more unifying solution to some very real, but solvable problems. I can’t wait to test out our processes and excel in whatever circumstances are ahead.

At Valley Behavioral Health, we stand ready to adapt to whatever our community leaders decide, and look forward to helping inform the debate when the time comes.

Let’s Deal with ACA Together!

I look forward to more discussion in our next leadership meeting!

Best,

Gary Larcenaire

By Valley Dev

The average, everyday person can be prepared to help

B. Todd Thatcher, DO, CMRO, Chief Medical Officer

 

Not long ago, lifesaving medical treatment was strictly the domain of doctors and nurses. If your heart

stopped and you collapsed, or you choked on food, you were probably not going to survive unless a

medical person was standing right there. Understandably, doctors, nurses, and paramedics, can’t be

everywhere, all the time. The problem was access to immediate emergency care outside the hospital.

The solution was training everyday people to administer cardiopulmonary resuscitation (CPR), and the

Heimlich Maneuver.

Training campaigns started in the late 1950’s. They have saved millions of lives, and changed the way

we conceptualize emergency medical care. Power to treat was transferred from the medical providers

to the average person on the street. Society learned ordinary people could make an important

difference. A similar phenomenon is taking place in the treatment of behavioral health and substance

abuse problems, and Valley Behavioral Health is leading the way.

The fundamental problem is the same as cardiac arrest, or choking; when emergency treatment is

needed there isn’t time to rush to the hospital or wait for the ambulance to arrive. Treatment needs to

start immediately, and society is learning that the ordinary person can play a very important role.

Take opioid (heroin and pain pills) overdoses as an example. Without immediate medical intervention,

people can stop breathing and die. Since the 1980’s, a drug called naloxone has been readily available in

hospitals to reverse the overdose. The problem is that people don’t usually overdose in the hospital.

They overdose in the streets and in their homes, far from the life-saving treatment they desperately

need. To save lives, naloxone is now available without a prescription to the everyday person. With a

little instruction, that person is now equipped to be the first step in stopping the overdose epidemic.

Valley Behavioral Health has taken a leading role along with other community partners like

Utahnaloxone.org, to distribute naloxone and educate the public. Both of our organizations have seen

lives saved by this initiative.

According to the Treatment Advocacy Center and USA Today, people with mental illness are 16 times

more likely to be killed by the police than other groups. Our brave citizens serving in law enforcement

are called to respond daily to mental health and substance abuse emergencies. They are good people

who want to do the right thing. They have been caught in the gap between the criminal justice and

mental health systems. Once again, psychiatrists, psychiatric APRN’s, therapists, and case managers,

can’t be everywhere all the time, so law enforcement is being trained to start delivering mental health

care at the scene.

Crisis Intervention Team (CIT) for law enforcement is a national program to train select law enforcement

officers to better respond to mental health crisis calls. Started in 1988, over 2,700 police departments

across the country have been trained, according to the American Psychiatric Association. They also

report research showing that CIT trained officers are more likely to divert people to mental health

treatment than jail, and less likely to arrest. For years, Valley Behavioral Health, along with other

community partners like the University of Utah, has helped provide CIT training. In Summit County,

Valley will train officers May 8th – 12th .

It’s hard to imagine a world without first-aid treatment. It seems everyone, from Boy and Girl Scouts, to

school teachers, to bus drivers, to office workers has been trained. The movement to train everyday

people to provide this type of treatment started in 1859, and led to the founding of the Red Cross. It

has saved millions of lives. In the same way that people who are bleeding need immediate help, people

suffering a mental health crisis need help as well. In 2001, Mental Health First-Aid (MHFA) was created

to deliver that help. According to mentalhealthfirstaid.org, there are now 11,800 certified instructors

who have trained over one million people nationwide.

Valley Behavioral Health has taken a leadership role in providing this much-needed training for Summit

County. Recently, Valley helped train hospital staff, and law enforcement officers in MHFA. Several of

our staff sit on community councils and committees to help this training flow to as many people as

possible. In addition, we provide training in Question-Persuade- Refer (QPR); a method of responding to

people thinking about committing suicide. The training takes about two hours and is designed for the

average, everyday person who wants to be prepared to help someone thinking about suicide.

If you want to be prepared to make a difference in the lives of your friends and neighbors, please

contact Valley Behavioral Health in Summit County. Our office is located at 1753 Sidewinder Drive. Our

phone number is 888-949- 4864. Our web address is valleycares.com. We are ready and eager to assist

you.

By Valley Dev

The care and cultivation of the provider personality

Gary Larcenaire, CEO Valley Behavioral Health

 

“I care more than you do obviously. I’ve given up everything”

As an early case manager a common problem among my clients with significant mental illness was
basic hygiene. I met with the director of a community college for cosmetology, and arranged for
students to provide hair and nail services to improve their health and quality of life.
When discussing this in a staffing and sharing this arrangement, some of my veteran colleagues
were very harsh in educating me that “THEY spent after hours and weekends actually performing
these services themselves”. I felt a tinge of shame.
That was the beginning of my experience in what I call: “I care more than you do contests”. In social
services, healthcare and psychiatry, I’ve heard colleagues cite all they have sacrificed: personal
relationships, their own health and personal time, clothing, resources etc.
Many times, those who have consistently “won” these contests of “comparative caring”, also won
promotions to leadership positions. It seemed that their professional elevation and identity was a
result of always being the most caring.

They hurt most when others experienced suffering

The individuals most able to survive and thrive in “human care-oriented systems” have certain core
qualities that are essential ingredients upon which we build crucial systems of support and service
to others.
But we must commit to better care for these providers, or risk losing them. Why? because those
same core qualities, if left unchecked can lead to an unhealthy view that: the secondary
prioritization of personal needs, the neglect and failings of personal relationships distinguish
themselves as “truest in their commitment to the cause”.
Similar to a view that substance abuse is the hallmark of a great musician, self neglect in all areas
can become the hallmark of the most committed care/service-oriented worker.

Allowed to develop without solid mentoring, an unspoken mantra can emerge: “the only true road to
status, peer recognition and promotion in a care-oriented profession is a personal life marked with
failed relationships or other signs that the provider is simply “too overwhelmed with the fulfillment
of the needs of others to be bothered with the “unimportant minutiae” of completing the tasks
which are critical for the responsible, sustainable management of a life (or a business model).

Accordingly, as a subset of our wellness committee work, we will adopt a secondary mission
statement for administration: “The care and cultivation of the provider personality”.

 

An evolution of the concept of a “fully developed behavioral health leader”.

 

Let’s flip the criteria for identifying elite provider staff. Let’s work to make it that: a personal
commitment to wellness, positive peer engagement, healthy personal relationships, along with
responsible business practices, are recognized as evidence of an elite commitment to our clients
and our field.
Let’s leave behind the pathology of self, and programmatic neglect, as a sign of the truest
commitment and validation of us as caring professionals.
I look forward to discussing this more in person.

By Valley Dev

Looking Ahead: 2017

Gary Larcenaire, CEO Valley Behavioral Health

 

We have an ambitious agenda for Valley and its affiliated brands in 2017!

We will strive to pivot from defining outcomes exclusively as “the absence of something bad happening”
such as a suicide or hospitalization, to a focus on improving daily functioning and the quality of the lives
our clients lead.

System-wide communication improvement, expansion, and technological advances will consume
most of our focus as we develop greater agility and gain more nimble organizational adaptation in
2017.

Highland Springs will unveil and launch a significant technological advancement in Q3 which has been
under development for the past year.

Our Highland Springs Orem Clinic will be state of the art and fully operational in Q2, with another
launch in an area-yet to be selected- by Q4. Highland Springs will unveil and launch a significant
technological advancement in Q3 which has been under development for the past year.
Our Leadership and Advocacy Task Force at the Carmen B. Pingree Autism Center of Learning will
work collaboratively to identify service needs and develop programs for our children with autism
as they grow into adulthood.

Valley has made significant strides in aligning employee and customer experiences to ensure those
experiences are consistent with our core values.

We will work collaboratively to identify service needs and develop programs for our children with
autism as they grow into adulthood.
We will continue to work toward a fully integrated behavioral/primary care clinic in West Valley.
Our wellness committee will continue to lead innovation in wellness and develop insurance coverage
arrangements which are fully congruent to Valley’s core values. In 2017 our marketing will become
more focused on how it returns value and educates our communities.

We will work collaboratively to identify service needs and develop programs for our children with
autism as they grow into adulthood.

We will continue to improve access to services in our schools and will continue our efforts to ensure
that all programs are focused on measurable clinical outcomes for all of the conditions that we treat.
We will strive to pivot from defining outcomes exclusively as “the absence of something bad
happening” such as a suicide or hospitalization, to a focus on improving daily functioning and the
quality of the lives our clients lead.

We will continue to work toward a fully integrated behavioral/primary care clinic in West Valley.

Valley has made significant strides in aligning employee and customer experiences to ensure those
experiences are consistent with our core values. We will get much better in 2017. 2016 was a big year

By Valley Dev

Valley Behavioral Health: a “Binge Worthy” Employer

Gary Larcenaire, CEO Valley Behavioral Health

 

On occasion, my wife and I spend a weekend enthralled or “binging” on a TV series. A compelling
story line and empathy for the characters is what makes for “binge- worthy” television.
Those same elements make Valley Behavioral Health a “binge-worthy” employer.
An employer that captures the imaginations of its employees every day. A company that strives to
earn enduring loyalty.

We are getting there: Valley Behavioral Health has reduced employee turnover by over 80% from
2015-2016!

Yes, thats right, over eighty percent! Not a typo.

Our story is that we care, and that we are always improving.

All companies have a storyline and characters. Our challenge was getting our story told accurately
so that employees can relate and become an essential part of making our tale one they can fall in
love with. Our dramatic reduction in employee turnover is not by accident. We are working hard to
become a first-rate career choice. We have improvements to mak e, but we are getting better.
Many things have worked to reduce employee turnover. Above all, we got two important things
right this year:

We know our story and we are telling it
Our story is that we care, and that we are always improving. The data tells the truth: we care about
our clients, our communities, and of course, our essential ingredient: our employees.
Social media and Slack have been our most effective tools in sharing our story widely. Slack has
brought us closer, and more connected as a work family. Routine data collection and distribution
keeps us honest. When we need improvement, we work harder. We are so much better today than
we were yesterday. And tomorrow is looking even better! Being data driven sounds easy.
But sometimes the truth hurts. When we don’t live up to our standards, we own it, and try harder.

We recruit and promote the right characters
All applicants interested in working at Valley Behavioral Health or its affiliated brands must first
pass what we refer to as a “micro screen”.
The “micro screen” is a fun group activity which presents the group a problem to be solved. Valley
recruiters monitor the enthusiasm and willingness of participants to engage as a group. Only
applicants that display enthusiasm and willingness to work collaboratively are advanced for
further consideration.
Each new hire and promotion is a referendum on our adherence to our core values. We take it that
seriously.
Yes, Valley is a “binge-worthy” employer. Once you start paying attention, you can’t get enough. And
the story is just getting started! If you’ve got what it takes, maybe you can join us one day! If you are
already on the team, you know what I am talking about already!

 

 

By Valley Dev

I promise, I am listening as hard as I can.

Gary Larcenaire, CEO Valley Behavioral Health

 

I’ve been privileged to lead teams from dark, hopeless places to lofty levels of performance.

Winning over teams who are experiencing dire, or even moderate financial, regulatory, customer satisfaction and/or clinical challenges is not easy. Many times a feeling of learned helplessness has crept in and their challenges may seem insurmountable.

In my experience, the causes of performance struggle range widely but most can be attributed to two things:

  1. lack of a collaboratively developed vision
  2. communication “dead zones”

A communication “dead zone” is exactly what it sounds like: A team, department, division, or an individual employee who isn’t sending or receiving messages accurately, timely, or at all. And this results in the death of team enthusiasm; and ultimately the divergence between brand expectations and experience.

Your teams will eventually discover the same root cause of performance struggles: “communication dead zones”

Communication dead zones create fertile environments for rumor and incongruent tribal development. Frankly, these zones can create “zombie” employees and teams barely recognizable to teams with normal functioning communication processes.

I have developed some creative ways of exploring and detecting “communication dead zones”. We will discuss these in our training sessions this year!

Happy Halloween!

Gary Larcenaire

By Valley Dev

Feel that? It’s Your Culture: Synchronous Resonance

Gary Larcenaire, CEO Valley Behavioral Health

I found two definitions of “resonance” with a simple Google search that reveal the secret of cultural
transformation. Musicians are trained early to recognize rhythm, tempo, and reverberation. As a
musician, I have come to understand corporate cultures in these terms. Listen closely when you
experience your favorite business. You will sense a tempo, a beat, a rhythm that resonates with
you favorably.

res·o·nance/noun 1. the quality in a
sound of being deep, full, and
reverberating.”the resonance of voice”

The first definition points to something critical in the establishment of corporate resonance and
that is: “voice”. Voice, to me is the internal narrative that finds its tempo and rhythm only in a
genuine establishment of non-negotiable core values.

2. PHYSICS the reinforcement or prolongation of sound by reflection from a surface or by the
synchronous vibration of a neighboring object.

The second definition contains three key words:”reinforcement, prolongation, and synchronous”.

These are essential ingredients for resonance to occur. Core values must be reinforced through the
referendum of hiring, training, promotion and termination daily over a prolonged period. Only then
will the echo effect begin to take hold and once resonance begins, it is hard to stop.

Synchronous resonance begins to take on an effect and power all its own which transcends the
personalities and efforts of literally anyone in an organization. And then, the magic occurs. Nearly
unstoppable. Goals are met with minimal effort and metrics seem to align themselves.

Have you experienced synchronous resonance in a company you worked for? Frequented?
Tell me about it.

I look forward to discussing this more in person soon.

Best,
Gary

By Valley Dev

Results-Oriented Behavioral Health

Gary Larcenaire, CEO Valley Behavioral Health

 

Public behavioral health is a poorly understood and complicated field; every aspect really. The way
we communicate about the benefits of investing in our service array can’t be. There is too much at
stake.
Effective behavioral health service systems prevent very expensive things from happening.
Our systems of care keep behavioral health patients out of expensive places where the benefits to
patient and society are questionable: emergency rooms, jails, court rooms, inpatient hospitals.
Of course we ease suffering and improve peoples lives, but those things are very difficult to quantify
and may hurt our credibility when negotiating, if emphasized too heavily.
The reduction of strain on those resources listed, IS the ultimate measure of our value when it comes
to appropriations, and managed-care contracting.
A clinical dash board that ignores the relative strain of those resources is incomplete and weakens
our ability to quantify our value.
I look forward to meeting and discussing the ways that we can improve the marketing of our
cost-savings outcomes together at our next meeting!
Best,
Gary Larcenaire

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